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<span id="printtitle">IQCare SCM User Guide V3.5.3</span><br />
<h1 class="p_Heading1"><span class="f_Heading1">Post Exposure Prophylaxis Register</span></h1>
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<td style="vertical-align:top; padding:2px;"><p>This register covers information needs for the management of health workers who may be exposed to Human Immuno-Virus or Hepatitis B Virus during the course of their work, other workers, such as the police, people who may be sexually assaulted and exposed to HIV or any other person who may be exposed to HIV.</p>
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<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A2_ICON" class="dropdown-toggle-icon" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A2','TOGGLE0186A2_ICON')">Purpose</a></span></td></tr></table></div><div id="TOGGLE0186A2" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
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<td style="vertical-align:top; padding:2px;"><p>This register is an extension of the existing register which was designed for health workers only. This edition covers all other persons who come to the facility to seek post-exposure interventions at the facility.</p>
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<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A3_ICON" class="dropdown-toggle-icon" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A3','TOGGLE0186A3_ICON')">When Completed</a></span></td></tr></table></div><div id="TOGGLE0186A3" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
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<td style="vertical-align:top; padding:2px;"><p>Depending on how the facility is organized, the first seven (7) columns can be completed when the client contacts the facility and the remaining columns can be updated as the service is offered or the intervention is provided. </p>
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<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A4_ICON" class="dropdown-toggle-icon" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A4','TOGGLE0186A4_ICON')">Who Completes the Form</a></span></td></tr></table></div><div id="TOGGLE0186A4" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
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<td style="vertical-align:top; padding:2px;"><p>Each facility can decide who completes the register, bearing in mind aspects such as the training of the staff member and confidentiality. </p>
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<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A5_ICON" class="dropdown-toggle-icon" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A5','TOGGLE0186A5_ICON')">Fill in a New PEP Register Form</a></span></td></tr></table></div><div id="TOGGLE0186A5" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
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<td style="vertical-align:top; padding:2px;"><p>The active technical area should be PEP Register</p>
<p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">1.</span>From the Patient Home Page, click on the Create New Form link and select the PEP Register.</p><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">2.</span>Fill in the form, making sure you fill in the required fields. Note that some of the fields will be auto populated.</p><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">3.</span>Click Save</p><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">4.</span>IQCare displays a message alerting you of any required fields not filled in</p><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">5.</span>IQCare displays a message alerting you of a successful save and asks you if you wish to exit or stay on the form (for continued field data entry.) </p></td>
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<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A6_ICON" class="dropdown-toggle-icon" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A6','TOGGLE0186A6_ICON')">Update PEP Register Form</a></span></td></tr></table></div><div id="TOGGLE0186A6" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; padding:2px;"><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">1.</span>To access a previously filled PEP Register form click on View Existing Forms and find the PEP Register and click the link</p><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">2.</span>Update the form</p><p style="text-align: left; padding: 0px 0px 0px 15px; margin: 0px 0px 0px 10px;"><span style="font-size:10pt; font-family: 'Arial';color:#000000;display:inline-block;width:15px;margin-left:-15px">3.</span>Click Save</p></td>
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<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A7_ICON" class="dropdown-toggle-icon" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A7','TOGGLE0186A7_ICON')">PEP Example Form</a></span></td></tr></table></div><div id="TOGGLE0186A7" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; padding:2px;"><p><img src="kepepregisterform.png" width="930" height="1495" alt="KEPEPRegisterForm" style="border:none" /></p>
</td>
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</table>
</div>
<p style="text-indent: -18px; margin: 0px 0px 0px 28px;">&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none;border-spacing:0px;padding:0px;line-height: normal;"><tr style="vertical-align:baseline"><td style="border:none;padding:0;width:18px"><img id="TOGGLE0186A8_ICON" class="dropdown-toggle-icon" src="hmtoggle_arrow1.gif" width="9" height="9" alt="hmtoggle_arrow1" style="border:none" /></td><td style="border:none;padding:0"><span style="font-weight: bold;"><a class="dropdown-toggle" href="javascript:HMToggle('toggle','TOGGLE0186A8','TOGGLE0186A8_ICON')">Data Dictionary</a></span></td></tr></table></div><div id="TOGGLE0186A8" style="text-align: left; text-indent: -18px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 28px;"><table class="toggletable" style="border:none; border-spacing:0px;">
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; padding:2px;"><div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="border:none; border-spacing:0px; border-collapse:collapse;">
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<th colspan="8" style="vertical-align:top; height:27px; background-color:#0000ff; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 16pt; font-family: Calibri; font-weight: bold; color: #ffffff;">PEP Register</span></p>
</th>
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<td style="vertical-align:top; width:152px; height:58px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Form/Registration</span></p>
</td>
<td style="vertical-align:top; width:143px; height:58px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">FieldName (no spaces)</span></p>
</td>
<td style="vertical-align:top; width:144px; height:58px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Labeled (In the form)</span></p>
</td>
<td style="vertical-align:top; width:151px; height:58px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Options/list/units</span></p>
</td>
<td style="vertical-align:top; width:109px; height:58px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Nature of the field</span></p>
</td>
<td style="vertical-align:top; width:140px; height:58px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Associated fields</span></p>
</td>
<td style="vertical-align:top; width:97px; height:58px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Required Field (Yes/No)</span></p>
</td>
<td style="vertical-align:top; width:79px; height:58px; background-color:#99ccff; padding:0px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Data Quality Check (Yes/No)</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Client Information</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">ClientType</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Client Type</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
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</td>
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<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Client Information</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">OtherExposureNature</span></p>
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<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Other Exposure Nature</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Text single line</span></p>
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<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Client Information</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Cadre</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Cadre</span></p>
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<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
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</td>
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<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Client Information</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">OtherHealthWorker</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Other Health Worker</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Text single line</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Cadre</span></p>
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Client Information</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">NonHealthworker</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Non Health worker</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Text single line</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Description of Exposure</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Date</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Date of exposure</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Date</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Description of Exposure</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">ExposureTime</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Timing of Exposure</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Text single line</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:116px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Description of Exposure</span></p>
</td>
<td style="vertical-align:top; width:143px; height:116px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">ExposureLocation</span></p>
</td>
<td style="vertical-align:top; width:144px; height:116px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Location of Exposure</span></p>
</td>
<td style="vertical-align:top; width:151px; height:116px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Medical Ward, Surgical Ward, Theatre, Dental Clinic, OP/MCH, Laundry, VCT, Other Location</span></p>
</td>
<td style="vertical-align:top; width:109px; height:116px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
<p>&nbsp;</p>
</td>
<td style="vertical-align:top; width:140px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">OtherExposureLocation</span></p>
</td>
<td style="vertical-align:top; width:97px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:116px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Description of Exposure</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">OtherExposureLocation</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Other Exposure Location</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Text single line</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Description of Exposure</span></p>
</td>
<td style="vertical-align:top; width:143px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">ExposureNature</span></p>
</td>
<td style="vertical-align:top; width:144px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Nature of exposure</span></p>
</td>
<td style="vertical-align:top; width:151px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Occupational, Sexual Assault, Other</span></p>
</td>
<td style="vertical-align:top; width:109px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:58px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:58px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:58px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Description of Exposure</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">OtherExposureNature</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Other exposure </span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Text single line</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">ExposureNature</span></p>
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Description of Exposure</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">ExposureSeverity</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Severity of exposure</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Superficial, Deep</span></p>
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Specimen status</span></p>
</td>
<td style="vertical-align:top; width:143px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIVSpecimenStatus</span></p>
</td>
<td style="vertical-align:top; width:144px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIV specimen status</span></p>
</td>
<td style="vertical-align:top; width:151px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIV Positive, HIV Negative, HIV Status Unknown</span></p>
</td>
<td style="vertical-align:top; width:109px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:58px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:58px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:58px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:77px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Specimen status</span></p>
</td>
<td style="vertical-align:top; width:143px; height:77px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HBVSpecimenStatus</span></p>
</td>
<td style="vertical-align:top; width:144px; height:77px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HBV Specimen Status</span></p>
</td>
<td style="vertical-align:top; width:151px; height:77px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HBVsAG Negative, HBVsAG Positive, Vaccinated, Unknown</span></p>
</td>
<td style="vertical-align:top; width:109px; height:77px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:77px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:77px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:77px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Specimen status</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIVRisk</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Risk of HIV</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">High, Medium</span></p>
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP History</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEPAdultDuration</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP for Adults (duration)</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Numeric</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP History</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEPAdultRegimen</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP for Adults</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP History</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEPChildDuration</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP for children (duration)</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Numeric</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP History</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEPChildRegimen</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP for children</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Baseline Status</span></p>
</td>
<td style="vertical-align:top; width:143px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIVBaselineStatus</span></p>
</td>
<td style="vertical-align:top; width:144px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIV</span></p>
</td>
<td style="vertical-align:top; width:151px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIV Positive, HIV Negative, HIV Status Unknown</span></p>
</td>
<td style="vertical-align:top; width:109px; height:58px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:58px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:58px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:58px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:77px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Baseline Status</span></p>
</td>
<td style="vertical-align:top; width:143px; height:77px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HBVBaselineStatus</span></p>
</td>
<td style="vertical-align:top; width:144px; height:77px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HBV</span></p>
</td>
<td style="vertical-align:top; width:151px; height:77px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HBVsAG Negative, HBVsAG Positive, Vaccinated, Unknown</span></p>
</td>
<td style="vertical-align:top; width:109px; height:77px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:77px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:77px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:77px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">CurrentPEP</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">CurrentPEPStart</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">StartDate</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Date</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">CurrentPEP</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">CurrentPEPTime</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">StartTime</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Text single line</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP Completion</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEPCompleted</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP Completed</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Yes, No</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP Completion</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">CurrentPEPComplete</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Date PEP completed</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Date</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP Completion</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">ReasonNotCompletingPEP</span></p>
</td>
<td colspan="2" style="vertical-align:top; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Reasons for not completing PEP</span></p>
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">PEP Completion</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">OtherReasonNotCompletePEP</span></p>
</td>
<td colspan="2" style="vertical-align:top; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Other Reason Not Conmpleted PEP</span></p>
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Text single line</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIV Status at</span></p>
</td>
<td style="vertical-align:top; width:143px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">3weeksHIVStatus</span></p>
</td>
<td style="vertical-align:top; width:144px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIV status at 3 weeks</span></p>
</td>
<td style="vertical-align:top; width:151px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Positiev, Negative, Unknown</span></p>
</td>
<td style="vertical-align:top; width:109px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:39px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:39px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:39px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIV Status at</span></p>
</td>
<td style="vertical-align:top; width:143px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">3monthsHIVStatus</span></p>
</td>
<td style="vertical-align:top; width:144px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIV status at 3 months</span></p>
</td>
<td style="vertical-align:top; width:151px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Positiev, Negative, Unknown</span></p>
</td>
<td style="vertical-align:top; width:109px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:39px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:39px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:39px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIV Status at</span></p>
</td>
<td style="vertical-align:top; width:143px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">6monthsHIVStatus</span></p>
</td>
<td style="vertical-align:top; width:144px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">HIV status at 6 months</span></p>
</td>
<td style="vertical-align:top; width:151px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Positiev, Negative, Unknown</span></p>
</td>
<td style="vertical-align:top; width:109px; height:39px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Select list</span></p>
</td>
<td style="vertical-align:top; width:140px; height:39px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:39px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:39px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:152px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Remarks</span></p>
</td>
<td style="vertical-align:top; width:143px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Remarks</span></p>
</td>
<td style="vertical-align:top; width:144px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Remarks</span></p>
</td>
<td style="vertical-align:top; width:151px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:109px; height:19px; padding:0px; border:solid 1px #000000;"><p><span style="font-size: 9pt;">Text multi Line</span></p>
</td>
<td style="vertical-align:top; width:140px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:97px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:79px; height:19px; padding:0px; border:solid 1px #000000;"><br />
</td>
</tr>
</table>
</div>
</td>
</tr>
</table>
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